Breast

Question 1

Between breast & pectoral (deep) fascia

• allows free movement of the breast
• cancer invasion –> pectoralis major contraction –> whole breast move superiorly

Answer 1

Retromammary space

Question 2

For support

Extends from dermis to pectoral (deep) fascia

Cancer invasion –> skin dimpling or nipple inversion

Answer 2

Suspensory (cooper) ligament

Question 3

For contour & size

Answer 3

Adipose tissue

Question 4

Modified sweat glands consisting of acini

Acini –> 15-20 lactiferous ducts –> lactiferous sinus (milk reservoir) –> nipple

Answer 4

Glandular tissue (mammary gland)

Question 5

Arterial supply

Answer 5

Internal thoracic artery

Lateral thoracic artery

Intercostal artery

Question 6

Venous drainage

Answer 6

Chief: Axillary vein

Others: internal thoracic vein, lateral thoracic vein, intercostal vein

Question 7

Lymphatic drainage

Answer 7

Chief: Axillary nodes

Cancer invasion –> block lymph flow –> thick, leathery skin (peau d orange)

Question 8

Sensory innervation

Answer 8

Intercostals nerves 2-6

Question 9

Nipple secretion

Answer 9

Contents:

• exfoliates duct cells
• a-lactoalbumin
• immunoglobulins
• lactose
• cholesterol
• steroids
• fatty acids
• caffeine, ethanol, nicotine, barbiturates, pesticides & technetium

Question 10

Nipple discharge

Answer 10

Benign cause:

• green, milky, yellow or brown
• bilateral
• not spontaneous
• affects multiple ducts

PITUITARY ADENOMA (prolactinoma)
- Galactorrhea + headache + loss of peripheral vision

Malignant cause:

• bloody or clear (serous)
• unilateral
• spontaneous
• affects a single duct

Question 11

Benign, glands are compressed into cords of epithelium

Sharply circumscribed, spherical nodule, movable

Answer 11

Fibroadenoma

Question 12

Most common breast cancer

Malignant, arranged in cell nests, cords,, anastomosing masses

Jagged-edged, fixed mass

If (+) estrogen/progesterone receptor –> good prognosis

If (+) c-erb B2 oncoprotein –> poor prognosis

Mutation of BRCA 1 (a tumor suppressor gene) –> very high lifetime risk of breast & ovarian cancer

Answer 12

Infiltrating ductal carcinoma

Question 13

Surgical procedures for breast cancer

Answer 13

Lumpectomy
- primary lesion with clear margins

Axillary lymphadenectomy

• Level 1 LN (lateral to Pectoralis minor)
• Level II LN (behind Pectoralis minor)
• Level III LN (medial to Pectoralis minor) usually are NOT removed

Simple mastectomy

• all breast tissue, nipple-areolar complex
• preserve the long thoracic nerve –> motor to serratus anterior muscle (if damaged –> winged scapula)

Modified radical mastectomy
- skin, entire breast, Pectoralis minor & Axillary contents

Halsted radical mastectomy
- skin, entire breast, Pectoralis minor, PECTORALIS major & Axillary contents

Question 14

Lies in superficial fascia of anterior chest wall

Overlies the PECTORALIS MAJOR & SERRATUS ANTERIOR MUSCLES

Axillary tail - high percentage of tumors

Extends from rib 2-6 vertically, from sternum to MAL laterally

Answer 14

Breast